Hello, and welcome to ASGE Endo Hangouts for GI Fellows. These webinars feature expert physicians in their field, and I'm very excited for today's presentation. The American Society for Gastrointestinal Endoscopy appreciates your participation in tonight's event, Negotiating Your First Job Contract. Before we get started, just a few housekeeping items. We want to make this session interactive, so feel free to ask questions at any time by clicking the Q&A feature on the bottom of your screen. Once you click on that feature, you can type in your question and hit return to submit the message. Please note that this presentation is being recorded and will be posted within two business days on GILeap, ASGE's online learning platform. You will have ongoing access to the recording in GILeap as part of your registration. Now it is my pleasure to introduce our course director, Dr. Douglas G. Adler from Porter Adventist Hospital in Denver. Take it away, Dr. Adler. Okay. Awesome. Thank you. I appreciate it. Looks like people are still filing in. We've already got quite a good number, so let me just tell you guys a little bit about myself and kind of why we're here and what we're going to be talking about. I'm going to give a talk about really how to think about your first job, right? This is broadly applicable to maybe not your first job, but it's kind of going to focus a little bit on your first job after fellowship. This talk will be helpful whether you're looking at an academic job, a private practice job, or what they call a hybrid job where you have some sort of aspects of both. I've had three jobs. I finished fellowship in 2002. I've had three jobs. I was at the University of Texas for three years. I was at the University of Utah for about 16 years, and I've been here in Denver for the last two and a half years. My current job is what they call a hybrid job. I'm technically employed by a private group, and I'm working at a private hospital system, but I have a professorship. I have medical students, residents, and fellows with me every day. Starting July 1, we have our own advanced fellowship that we're running. I've negotiated for myself three contracts, but I was fellowship director at the University of Utah for seven years, and I looked at every contract that our fellows had. I've looked at quite a lot of contracts, and people just kind of know from around the country that I'm interested in this. A lot of people just call me and ask me to look at their contracts. The talk I'm going to give is about 30 minutes, and that should carry us until about 40 past the hour. Then we'll probably have about 20 minutes for Q&A. A good Q&A is always really helpful, especially with a topic like this. I'm going to share my screen real quick. You guys should be able to see that. Let me know if you guys can't. Again, I'm in Denver, Colorado. I run the Center for Advanced Therapeutic Endoscopy at Porter Adventist Hospital. I do pretty much just full-time advanced. There's not a lot in advanced endoscopy I don't do, but I guess that's fodder for another talk. I'll just start off by saying that when you go to look for a job at the end of fellowship, one of the hardest things to learn is that the worm has turned. What that really means is this experience is really going to go against everything you've previously experienced during your medical training. All of your prior applications and interview processes will bear no resemblance to applying for a job as an attending. That's true whether you're going to a private practice job, a university, or something else. That's because this is how you're used to being. This is how you guys perceive yourselves all through your undergraduate and medical training. You're essentially like a beggar. You're just begging. You're hoping and doing everything you possibly can so that somebody else will accept you to whatever program it is you're applying to, college, med school, internship, residency, fellowship, advanced fellowship. You guys have all gotten very, very good at being in this role, but that's done. That is all over now. It's time to stop begging. You can't think about it like that anymore. You've got to take that mindset and just completely put it away. That's because now your training is done. You're no longer needing a skill or needing a degree or a certificate or a diploma. You now have the cognitive and the technical skills that you need to succeed as a physician. Critically, for the first time, you can generate real revenue. This is what changes everything because you can, on the one hand, generate money for yourself and your family, but more importantly, from a negotiation point of view, you can generate revenue for your partners, for your practice, for the hospital or the hospital system you're going to work in. All of a sudden, it goes from you being the beggar, desperate to get accepted, to them really, really wanting you. They want physicians to work in their hospitals and clinics, see patients, do procedures, order CTs, generate a lot of revenue, business, referrals to other subspecialists, order CAT scans, all that stuff. All of a sudden, you're going to find that you're being courted. They're going to want you to join their job or practice. You're used to begging to get in. It's going to be the opposite. They're going to be trying very, very hard to recruit you. Because they're working hard to recruit you, it means that you need to negotiate. This is something that by and large, almost all of you will be terrible at, because you've never had to do this before. When you get into residency or fellowship, they hand you the contract and you just sign it. If you go to a job after fellowship, let's say you go to an HMO or a university, and they just hand you the standard contract and say, well, this is our standard contract for all our new hires, don't sign that. I've seen fellows do that, and it's always a mistake. You've got to look through that contract very, very carefully, see what they're really saying. When I say look through it carefully, I mean every word, every line with a pen in your hand. You need to understand what you're signing, because the minute you sign, you're really going to be held to it. In all of my jobs that I've applied for and gotten so far over the years, there were things I wanted that they said no to, and they said, oh, we definitely can't do that. You know what? They can do it. You can negotiate. Everything is negotiable. As I always like to say in life, you don't get what you deserve, you get what you negotiate. You've got to be willing to negotiate and recognize that this may be an unpleasant process. You've never really done this before. You may be worried about upsetting a potential employer, but you've got to negotiate. Now is your chance, because once you sign that paper, you're locked in, and the terms you sign on are the terms you sign on, and that's just how it goes. I get asked all the time, this is one of the most fundamental questions I ever get asked is, should you get a lawyer? The answer, without a moment's hesitation, is unequivocally yes. Oops. Hang on. I skipped a slide there. You should get a lawyer. A hundred percent, you must get a lawyer. I don't know if you want Saul Goodman to be your lawyer, but you definitely want a lawyer. The contract that you get is going to be probably on the order of 10 to 20 pages, and that contract is not written by physicians. That contract is written by the attorneys that your practice or your hospital has paid to write that contract. This is a legal document. It's not a medical document, and it's not something that you're going to be totally familiar with. Because it's a legal document drawn up by lawyers, you have to have a lawyer to read it for you, and go through it and translate it for you, the same way that when you read the CT report, you translate it for the patient and explain what's on their CAT scan or their MRCP. Your lawyer is there to go through everything with you with a fine tooth comb so that you understand exactly what is in that document. One of the toughest things for people to kind of wrap their brain around in this process is your lawyer is going to charge you money, right? And they're going to charge you probably a lot of money. A good contract attorney in most American cities will charge anywhere from $400 to $750 an hour. And you know what? You're going to pay it. Because it's worth it. Because you need a good lawyer to go through everything. And if you end up spending a couple of thousand dollars over the course of your contract negotiations, that is money very, very well spent. So don't look for the cheapest lawyer. Don't be stingy. You want to look for the best lawyer. This is like having an ERCP. You want the best person who does this all the time and understands all the ins and outs of the process. That's who you want to be your lawyer. Let me tell you who you don't want to be your lawyer. Your friend from high school. Not your lawyer. Your spouse who's an attorney. Not your lawyer. Your father or your mother who's an attorney. Not your lawyer. None of those people are appropriate. They're not objective. You need somebody who's really, really a professional and will be objective about this and will honestly just treat you like a regular client. You don't want your mother negotiating your contract for you. It's also critical to recognize that you're going to go through most likely several drafts of your contract. And on all of my jobs I've ever had, we went to multiple rounds of contracts. And I think on one of my jobs, we went through seven rounds of the contract. And at one point, my prospective employer said to me, why, like, are you ever going to sign? And I said, I'll sign when it's right. And you know what? I signed when it was right. So just recognize you don't sign until you're 100% comfortable with that document. So there's a lot of things to pay attention to in the process of sort of thinking about a job and negotiating with your prospective employer. So the first thing I want to talk about is start date, right? You've got to be very realistic about this because I guarantee you your employer is going to want you to start immediately because the sooner you start, the sooner that you start taking call, seeing patients, and most importantly, generating revenue, right? So they're going to want you to start right away. And you want to sort of generally take a little more time because it can be a big, big, big change in life to start a job. And for example, every job I've ever had came with a move. You may have to sell your home, may have to buy a new home or rent a place while you figure out the lay of the land in a new city, right? You may have to get a state license and sometimes that's fast and sometimes it's not. And for example, when I got my Colorado license a couple of years ago, it took 48 hours. I was absolutely shocked. I'd never gotten a license so fast. But when I moved to Utah and I applied for my license, it took, I think, 90 days and I didn't have a license. I just filled out all the paperwork and they just told me to wait. And I had it just that there was nothing I could do until I got the document. If you are a graduating fellow, you probably need to study for the boards. A very, very common mistake is people don't really study for the boards and they say, well, I'll study when I'm in my new job. I'll just work at night. And then it's almost impossible. You're going to get home, you're going to be tired, you're going to be exhausted, you're going to want to eat dinner and relax a little bit. You're going to look up and it's nine o'clock and you're not going to do any studying at nine, right? So you may want to take 30, 60, 90 days to get a lot of studying for the boards. And I cannot overemphasize the critical importance of passing your boards, right? And God forbid, right, you failed your boards and you're taking them again, right? You want to, again, have some time to study for that. You want to really understand the job you're being hired for. And this is really your clinical duties, right? And you have to ask a lot of questions. And most people don't do this, right? They read the contract. The contract is often worded very broadly and they don't really understand what they're signing. And actually, I was guilty of this on my very first job when I was at University of Texas. I didn't really understand a lot of what was in that contract and I signed it. It was my first job. And then when I got there, and I'm not trying to throw shade at the University of Texas, but when I got there, the job was very, very different than I had believed it was going to be. And my schedule and my hours were not really what I was expecting. And you want to ask about call. How often will I be on call, right? What does call entail? What time does call start? What time does call finish? Who's my backup, right? All these things. Like, they'll just say like, oh, you'll take call every fourth or something like that. But you really need to understand what that call is. And we'll talk about that a little bit further down. How often are you in clinic? How many patients are you expected to see in a half day of clinic? What sort of support do you have? Do you have an MA, right? Does your MA just work with you? Does your MA take care of 10 other doctors and not really have any time for you, right? I wrote here OR time, but what I mean is procedure time. Like, how many half days of endoscopy a week are you going to get? Is that carved in stone? Can the senior partners kind of squeeze you out of your endo time because they have seniority, right? How much admin time are you going to get, right? If you're taking a university job, I strongly believe that you should have at least one day a week of protected time so you can try to do some writing, right? Do some academic work. If you don't want to do academic work, probably shouldn't take a job at a university. But even if you take a job in private practice, you will need half day a week to do admin work, right? Send letters to patients, make phone calls, right? You will be shocked at how much this stuff builds up. People who work with me know that I often call 10 to 20 patients a week on the phone to just answer a question or run something, you know, run something by them or discuss a lab result. Like, it takes time. And even a quick phone call takes 10 minutes and then you have to chart it. So if you got a lot of calls, you could see how very quickly that spins up to a lot of time. It's good to ask members of the group how accurately their contract reflects their actual day-to-day job or their work week, and you're probably going to find it doesn't reflect it that accurately. As you go in your job, your clinical schedule and your clinical work, the sort of duties will often drift from your contract. But again, for that first six months or one year, you want to really, really, really be able to understand what it is you're walking into. And a lot of people don't do that. And again, when I did my first job, that was a mistake I made. And I really didn't understand the schedule that I got into. And the schedule I got into was much denser and much more crowded than I had understood. So again, back to call, right? Like, call means different things in all sorts of places, and you got to understand what you're signing up for. Are you covering one hospital? Are you covering multiple hospitals? I've had more than one of my former fellows call me in a hysterical panic a month into their job when they were on call covering a series of five hospitals that were 20 or 30 miles from each other. And they were spending the entire day in their car, driving from one hospital to the next, only to get a call back at the first hospital that they had to go turn around and drive 45 minutes to go back and see a consult. This happens all the time. And a lot of groups cover multiple hospitals. Are you covering just for your group or does your group share call? How well are the other physicians respected in the community? Is their practice pattern different than yours, right? Do their clinical, you know, the way they handle patients, is that different than the way your group handles patients, right? Just how much weekend call do you get? How much weeknight call, right? Are the holidays broken up evenly? Very, very common. The new person gets a disproportionate amount of the holiday call or the three-day weekend call, right? Who's your backup? What if you get sick? Is there someone to back you up? What if you get overwhelmed and you get 20 consults and you just cannot see 20 consults spread across four hospitals? Is there someone that you can call that can physically come in and back you up? Or is the answer to that question, no, and you're totally on your own, right? Critically, is the call fair? And a lot of places put disproportionate call on the junior person. Now, sometimes junior people want that because it allows them to build up their practice quickly, but other times they don't want it and they may feel like they're getting dumped on and the senior partners may view you as sort of fresh meat for the grinder that they can put a lot of call on so they can sharply cut back their call coverage. Something else you probably have never thought about in your job as a fellow is that many places pay you for call, right? And for example, a lot of places, if there's pay for call, people aggressively pursue the call as a way to really increase their revenue. So just ask, is there a pay for call? What's the pay for weeknight? What's the pay for weekend, right? And there's usually a differential. And again, you need to know what is the pay, right? And if you don't ask, maybe they don't give it to you, right? So again, you got to think about all these things. I'm not gonna say a ton about compensation because it's actually in a lot of ways the least interesting part of this talk. It's also in some ways the least important part of the contract, right? You're gonna be so focused on this number, this magical number of how much money they're gonna pay you, but it's really not gonna be a huge source of discussion, right? The salaries are often very easy to find out what other people in the group are making, or if you're in some states, for example, a lot of salaries at the universities are public. You can just look everything up, get a sense of what they're paying, and they'll tell you the pay schedule for the first couple of years, and you can kind of get a sense of things. I will tell you that a few dollars more or less is not gonna decide your future, and you're very unlikely to leave a job because of the pay. Because again, GI salaries are pretty good. We're very lucky in that respect. Gastroenterologists are paid very well in this country, and you're probably not gonna have a hard time finding a job to pay you pretty well. Just recognize you're most likely to leave a job down the road over non-financial issues. And again, there's a lot of transparency here, so you really are not gonna have a lot of debate trying to figure out what an appropriate salary is for you in a particular city or a particular part of the country. It'll be pretty simple. If you really, really, really want a lot of money, and you'll get one of those mailings that says, a great GI job, $800,000 a year, beautiful college town, it's probably gonna be in the middle of nowhere. So some people have significant debt, or their spouse has significant debt, or they just really want a lot of money. And you may find yourself looking very seriously at one of these extremely high paying positions, literally in the middle of nowhere. These jobs have pros and cons, right? You are very, very likely to command a lot more money in a job like that. And a lot of those jobs are in nice hospitals with good systems, but most people don't stay because it is very, very hard to live in an extremely remote or rural place. There tends to be a lot of turnover. People come for a few years to make some money, put some money in the bank, and then they kind of hightail it. When I was finishing my advanced fellowship, I did go look, I will admit, I did go look at one of these jobs. I went and looked at an exceptionally high paying job that was like, it was in such a remote place, you couldn't believe it. And I brought my wife and our baby on the job interview and my wife took one look at the place and she was like, nope. She was like, don't even consider it. We're never, ever going to live here. So just recognize if it's not good for your family, it's not good for you. You don't wanna take a job in the middle of nowhere and be at the hospital all day and your spouse has nothing to do and nowhere to go. You may get fired, right? So you need to think about termination clauses in your contract, right? Your group may decide that it's not working out and they wanna get rid of you. And this happens all the time. So obviously your contract terminates if you die and many groups will have a disability clause. And if you become disabled and can no longer work, they will terminate you. And that is legal if you sign it. They can also fire you for cause. If you commit a crime, most notably a felony. If you lose your license, right? If there's a state action against you or the state board moves against you and you lose your license, you can be fired. If you become uninsurable, like if you have, you know, in a certain period of years, too many lawsuits against you and you lose them, right? And you become a liability and insurance companies won't allow you on their plan or you get dropped from Medicare, right? They can just fire you for cause, meaning they've got a good reason to let you go. That's the cause part. They may also have a stipulation in your contract that they can fire you without cause. And that basically means we don't like you, right? Typically it's within six to 12 months. A lot of practices will have a six to 12 month clause in the contract where they can fire you basically for any reason at any time. So you're kind of on probation, right? And that probation is common across many, many industries and medical contracts often have essentially a de facto probation clause. So just recognize, you know, your first year, they're gonna be watching very, very carefully how well you're doing, how your business is flowing, how your practice is being built, how your procedure outcomes are going. And again, if at the six or nine month mark comes and they're worried, they may very well just let you go and you may find yourself suddenly unemployed. Restrictive covenants is a whole other talk, but I will tell you that you need to recognize that restrictive covenants are real. And depending on the state you are in, they may or may not be rigorously enforced. As a general rule, if the state that you are in has a reputation for enforcing the restrictive covenants or has laws on the books that favor, right, the employer, you need to take that restrictive covenant extremely seriously. Some states, the state governments have actually watered down restrictive covenants quite a lot and they can become difficult to enforce. But again, just recognize that most states in the country, these restrictive covenants are very enforceable. And that basically means the employer has put a clause in to protect themselves from you, right? Like they don't want you to come into town, build up a practice, build up a reputation, quit, and then go to the hospital across the street, right? So they'll typically have time and distance requirements, i.e. you can't practice within 10 miles for three years, right? And they may say, like, for example, if the practice covers four hospitals, they may say, well, you can't practice within 10 miles of any of our sites for three years. And that's actually a very, very large area. In general, if you're in an urban area, the distance covered by the restrictive covenant will be small. And for example, in New York City, I've seen contracts where the restrictive covenant was one mile. But again, one mile in New York City may as well be a million miles. And in rural places, 10, 20 miles is often not uncommon. And some places have restrictive covenants of 50 miles. So just recognize, you know, if you don't wanna get in trouble with the restrictive covenant, you may find yourself having to move. Critically, the distance is as the crow flies, not as it is driven in a car. So just recognize that's how the distance in a restrictive covenant is measured. These are generally, if possible, these are enforced to protect the employer. The restrictive covenant does not help you. It helps the employer. You can ask for a couple of things. You can ask them to just drop the restrictive covenant. And if the practice really, really needs you or is desperate, you can sometimes get them to just drop the restrictive covenant. That's tough to do, but you can do it. You can also say, well, look, if I leave in less than 365 days, will you void the restrictive covenant? Meaning I haven't had time to build up. If it just didn't work out and I wanna leave and you want me to go, don't hold me to a restrictive covenant. That is fair to ask for. If you're terminated without cause, you may be able to say, well, look, I would like the restrictive covenant to be void if you terminate me without cause. And then you also can get a buyout option. And this is the most common. You can say, well, look, if I violate this restrictive covenant, will you give me the chance to buy my way out of it? Like for a quarter million or a half million dollars, can you void this restrictive covenant? And usually if that happens, your next employer will pay it. For example, if it's not working out, but the group down the street really, really wants you, maybe they'll pay a quarter million dollars to your old group to get it. You guys think I'm making up a number like that, but that's how this stuff actually works. Here are some things to think about asking for. And again, this applies to academic and private jobs. Relocation funds. You should ask them to pay for at least part of, if not all of your move. Moving isn't that much money, but again, if you're just starting training, that's money you shouldn't be spending out of your pocket. Sorry, if you're just finishing training. Educational time. You want to have time built into your contract that you can go to DDW and they won't hold it against you if you take time off to go to at least one or two meetings a year. They should also give you some educational funds. For example, most practices or universities will give you a little fund every year that generally covers enough to fly to a meeting, stay at a hotel and pay for the registration, right? They'll cover one meeting per year. And again, it's in their interest to have you be up to date in your practice and what you're doing, right? Some places, usually rural jobs will offer school loan repayment. And this sounds really, really appealing, but just recognize it comes with strings as do almost all things in these jobs, right? So if you go to North Dakota and you take a great job in Fargo, North Dakota, no disrespect to Fargo, North Dakota, probably a tough place to get doctors to go to, right? And you, let's say you have $500,000 in loans, right? From undergrad and medical school that you're laying awake at night, shaking about. You can ask them to do loan forgiveness. And the way this usually works is they will pay 20% of your loans per year for five years, right? So you gotta stay there for five years in Fargo, North Dakota before your loans are all paid off. And then usually you have to stay there for a specified amount of time after the loans have been paid off, usually three to five years, right? So then you're really, you know, you're signing a, you know, an eight to 10 year contract, but you get paid and your loans get paid off. And I know some people who have done that and they were very, very happy with it. And it really just took an enormous stressor off their plate, but recognize if you moved to Fargo, North Dakota, and it's not for you and you don't like it and you decide to leave at the two year mark, they will expect you to pay them back, right? They'll say, well, wait a second. We paid 40% of your loans already. Now you owe us that money. And you may find yourself paying that money back and then right back where you started with all that debt. What about a signing bonus? Everybody gets really, really, really wrapped up with this. It's the focus of a lot of attention. And in, for your first job, it's often actually a big headache. This changes as time goes on and you get further in your career, but for your first job, I would not worry too much about a signing bonus. It's usually not a tremendous amount of money. It's taxed at an extremely high rate. Like I always joke that the only downside of somebody giving you a $10,000 signing bonus is you gotta give $3,500 of it away in taxes, right? If your negotiation with your prospective employer is going well and you start making noise about a signing bonus, it may rub them the wrong way. So just recognize you don't wanna be penny wise and pound foolish. Like don't argue about the nickels and dimes that they're throwing dollars at you. And I used to always tell the fellows, like, do you need the signing bonus or do you just want it? And if you just want it, but don't need it and they don't offer, maybe just let it go, right? And I've seen a couple of fellows essentially lose a good job because they kinda got into a dumb fight about the signing bonus. Some people get a job or they can start to lock down a job early in their fellowship. And one thing you can do in that situation is you can ask for a stipend. And I've had fellows who signed on a job in their first or second year of fellowship and the practice said, well, we'll give you $1,000 a month while you're a fellow as a token of goodwill, right? So if you sign at the end of your first year, you've got two years of 1,000 a month as a stipend. So that's essentially $24,000 signing bonus before you even show up to the job. And let me tell you, when you're a fellow, an extra $1,000 a month goes a very, very long way. So that's something to consider asking for. And that's not so painful to the group. It's not a big sum of money for them. It's just a little bit of money every month and it builds goodwill between you and the group. So I just had a couple of final thoughts and we're right on time. It's 40 past the hour. This is really important. This may be the most important slide in the whole talk. Just remember that, you know, they need you more than you need them, right? You have the talent. You have the skills. You know how to get to the secum or cannulate the bile duct or place a stent or do an ESD, right? You have the skills that these hospitals and universities and groups want, right? So you've got to keep telling yourself, they need me more than I need them. And that's the vantage point that you should have in your mind during your discussions with the group, right? Another way to say it is that jobs are like buses. If you miss one, another will come along pretty soon to get you where you need to go. So like you want to sort of not have like, oh, this is the only place I can work or this is my dream job. Like that's a bad way to think about it, right? Make a list of what you're looking for and you'll probably find that there's a lot of jobs that fit that bill. Don't get too married to the idea of working at one place or in a very specific geographic area. You've got to be open to stuff and see where the best offers are. I always like to show this slide because it gets at the idea that you're probably not going to be in your first job forever, right? And you're actually probably not going to be in your first job for very long. Most GI docs will have two to four jobs during their career and some will have a lot more jobs. 50% of GI physicians will change jobs within three years of completing their training. And I left my first job exactly three years to the day. I walked out the door at three years. So that was me, right? You know, in your first job, you do a lot of learning. You learn a lot clinically, but you also learn a lot about what matters to you. And a lot of stuff that you think is important when you're a fellow really isn't. And a lot of things that you didn't even consider actually turned out to be very important. So it's not uncommon that after a year or two in your first job, you may be like, you know, this isn't really what I wanted, right? You may have taken a job in practice and missed the academic life and want to go back to the university. You may have taken a university job and decide, you know, this really isn't enough money for me. I want to go to private practice and make a lot more money. You may not like your partners, right? You may have interpersonal difficulties with your group or your partners, right, or hospital administrators. That happens all the time. Your personal life may change, right? Maybe you get divorced, right? I mean, nobody thinks that'll happen, but it happens all the time. Maybe you get married. Maybe one of your parents becomes very, very ill and you need to move back near your parents to help take care of them. Like these things happen, right? So just recognize you can never predict what's going to happen tomorrow. You may decide that living in Fargo, North Dakota, I feel so bad, I've never been to Fargo. I'm sure it's wonderful, but you may decide that Fargo, North Dakota really isn't where you want to live for the next 10 years to get your loans paid off. And then the other thing is the group may run into bad financial troubles. And I've had a bunch of my friends from medical school have this exact problem. And for example, by way of one vignette, a very, very good friend of mine was in Las Vegas and he had a fantastic job and he loved everything about it. And his group had a contract with three very, very large hospitals. And he used to always say how great it was and how he was never going to leave. And then another group outbid their group and got two of those hospitals. And they lost the contract at two of the three hospitals and they didn't have enough patients to see and the group went bankrupt. And he went from having the best job that he ever thought he could have to scrambling to find another job. And 10 years later, he's had three jobs since and none of them were as good. So just recognize the group may run into financial troubles that aren't your fault and you have nothing to do with, but it affects your life greatly. That is my last slide. I'm gonna stop my share and then we can open it up for questions. Looks like we've got about 40 people on the call. So please open it up to questions. I think that you can chat them or you might be able to speak them. That is correct. You can use the Q&A button down at the bottom of your screen. Go ahead and type in your question and then hit your enter return button and that'll post the question to the group. All right, I'm gonna, I'll just start. I'm looking at the Q&A and there's two questions already. I'll just start. Alex Fagan says, what are your feelings about recruiters? Should we stay away from them and contact hospital ourselves? And is that okay? Yes, it's totally okay. The good thing about recruiters is you don't pay them. The employer pays them. You should not pay one cent to a recruiter. That's not your job. The downside of recruiters is they are often very impersonal. Their goal is not to get you, Alec, the best job in the world. Their goal is to just get you in a job so that they get their cut. And their cut is often, you know, half a year's salary for you. It's quite a lot of money that recruiters make. So, you know, they just wanna stick you in a job so they get paid. So just recognize they may not have your best interest at heart. Shruti Khurana asks, what is a typical number of vacation days that a contract will have? In general, you will get 20 weekdays off. You will get four weeks off. That is very, very typical. Some practices will give you more, but recognize if you start taking more than four weeks off a year, it will start to eat into your revenue, right? Because the more, you know, when you're not there, you're not generating RVUs, you're not doing procedures, you're not seeing clinic patients. So just recognize that there's often a balance between revenue and vacation. And I have to say, and people who know me will tell you that this is true, I'm absolutely awful at work-life balance. I've been doing, you know, I finished my training in 2002, and I don't know if I've ever used all of my vacation in a whole year because I like being at work and I like doing procedures and I tend to underuse my vacation. But you also wanna ask, let's say you're really, really gung-ho and things are going great and you only take two weeks off. What happens to those other two weeks? Will they pay you for the extra two weeks or no? Or can you roll that vacation over to the next year and bank it? So that maybe after a couple of years of practice, you can take, you know, two months off and not have a penalty. So again, that's something to ask about when you negotiate. Syed, Syed Raza asks, how do you approach changing call frequency without sounding like you are just lazy? Well, maybe you are lazy, I don't know. So, in general, you can't really ask for anything more than fair call, right? If there's six of you in the group, call should be every sixth with some caveats, right? If you're taking biliary call, they may make an adjustment because that may be extra. If you're taking liver transplant call, they may make some caveats for you for it's a little extra. But by and large, if there's six people or group, it should be every sixth weekday and every sixth weekend, right? If there's 10 people, right, every 10th. And remember, you can always, once you join the group, if you want more call, I know it sounds crazy when you're the fellow to want to take more call, but if they're paying you more money, you may very want to take more call. You can often trade to take more call and see if you can trade to get out of it. I don't think you will look lazy if you just want to take fair call. I think if it looks like you want to take disproportionately less call, that will rub people the wrong way. So just recognize they're hiring you to work, right? They're hiring you to run around the hospital and do the thing you've been training for all these years. Bing Chen says for a fellow who will do advanced endoscopy, when is a good time to start looking for jobs? I would say the fall, right? So like October, November, December, you should be interviewing for jobs and you should hopefully wrap up your job search and your contract negotiations by late winter. You don't want to be sort of negotiating your contract at the very end of your advanced fellowship. They may not give you enough time to get set up. And that actually happened to me when I did my advanced fellowship. I did my ERCP at Mayo Rochester. I did a fourth year in advanced and I didn't sign my contract until May. And I was debating between two positions and it was a real struggle and I couldn't decide which one I wanted. And by the time I finally decided and was ready to move forward, it was getting very, very close to the end of my fellowship. And that caused me tremendous stress because I had to set up everything for that job very, very quickly because I signed so late. So you're much better off to do that earlier than later. Anonymous attendee says, I've heard that if you use a recruiter, you can expect your salary to be lower than if you contacted the practice hospital directly. The recruiter is not taking money out of your salary. That's not true. The recruiter is taking money from the practice. So I don't think that the salary is dependent on whether you get it through a recruiter or not. Remember, the recruiter doesn't negotiate for you, right? You negotiate. The recruiter just puts you in touch with the job and starts the process and they get paid if you sign, but you're still free to negotiate anything you want. So the presence or absence of recruiter should not affect your final salary. Joe Rinaldi says, in regards to your first job, how would you handle the discovery that the job you started is different in practice than the one that you signed a contract for? Well, that happened to me. And when I got to my first job, I was taking much more call than I ever thought I was gonna. When I interviewed, they had ex-faculty, and by the time I got there, they had lost some faculty. So I found myself covering inpatient service much more than I thought I was going to and covering a call much more than I thought I was going to. And I'm not gonna lie, that was a difficult realization that the job, literally the first day I got there was very different than I was expecting. And I stuck it out and I stayed there three years to the day, but it was a bit of a sore spot and I got over it. The call was fair, mostly, but it was hard. I was taking quite a lot of call. And for example, this is true, I'm not making this up. When I was at the University of Texas, I took a thousand days of ERCP call straight because I was there all alone. I was covering two very large hospitals and I didn't have any backup. So in addition to covering some general call, nights and weekends, I covered ERCP for 1,000 days straight. So it was good and bad. I never worried about my RBUs and I got incredible volume and tons of experience, but I covered call for 1,000 days straight. And let me tell you, that was tough. That was very, very tough on my wife and my family. Anonymous attendee asks, should we expect our employer to cover the malpractice tail? If you go, not necessarily, tail's not that much money. And if you go, better off to pay for your own malpractice if you have to. Do we ask for the contract or wait for the employer to offer it? Good question. You'll know, like it'll be obvious to you and the employer if it's time to draw up a contract, right? Usually don't expect anything on your first visit, but if you go for a second visit, right, or they ask you back for a second visit, at the end of the second visit, you can expect a contract to be produced unless you don't do a good job or it's obvious it's not gonna work out. Is it reasonable to ask about the group's finance before signing? It's 100% reasonable. And I will tell you something else. If you go to a university, you ask about the financial health of the division of GI, the department of medicine and the medical school as a whole. A lot of medical schools in this country are in very dire financial straits. So again, that's not just for practice, that's for a university job too. You wanna understand the financial health. And that may be something that you have to ask individual group members or faculty members about to find out, because the division chief or the president of the group may not be so forthcoming about the financial health of the group. When should we ask about maternity and paternity leave? When you're negotiating the contract, right? You can ask for maternity and paternity clauses in the contracts. Praneeth asks, how realistic is it to continue your research work if you choose a hybrid job? I'm in a hybrid job. And I think last year I had 48 publications. So, whether you're in a university or a hybrid job or even practice, you will do research if you care about research. People who know me know how much I care about research. It's literally what gets me out of bed in the morning. It's kept me super engaged my whole career. I'm over 500 publications. And when I left the University of Utah and came to Centura Health, a private system, my research output actually went up. So again, if it's important to you, you will do it wherever you are. If it's not important to you, it may fall away. And remember too, most people in academic jobs actually do very little research. So again, if the research is something that matters to you, you will find a way to do it. Somebody asks, what is the difference between an offer letter and a contract letter? I've never heard the term contract letter. An offer letter usually is like a cover letter that spells out some sort of like broad strokes, details about what they're offering on the high level, pay, bonuses, things like that. But again, a contract is a contract. And for example, for my current job, I think my contract was like 15 or 20 pages long. That's not a letter. That's a contract. That's a big document. We've got just a few more minutes. I'll take one or two more. Does the negotiation process occur over emails or phone calls? And the answer is yes. The contract negotiation is over emails. It's over phone calls. It's in person. It's through your lawyer. And I had my lawyer do some of the talking for me. Like sometimes I thought it was better for my lawyer to ask for certain things than for me to ask. And I would just have my lawyer call their lawyer and say he wants this. That's part of the lawyer's job is to speak on your behalf. So all of these things happen. Some things are better handled doc to doc. And some of these things are better handled lawyer to lawyer. We have time for one more question. If anybody wants to shoot one more question into the Q&A and then we'll wrap up. Going once, type fast. Jay Dubrov, I know Jay. Jay, good to see you here. How much should you expect to pay if you have an attorney? I said this in the beginning, Jay, you might've gotten here late. A good lawyer, and you want a good lawyer, you should expect to pay anywhere from about 400 to $750 an hour. And you know what? Lawyers work hard and they're working hard for you. Don't be stingy, don't be cheap. Pay your lawyer what they ask and don't try to negotiate them down on price. If that's their rate, that's their rate. You wouldn't want somebody to negotiate you down on your rate as a physician. All right, I will wrap it there. We are right at the top of the hour. I wanna thank the ASGE for this opportunity. I wanna take a minute to thank Mike's for helping out and run the session. And thanks everybody for attending. And again, the talk will be available as part of the ASGE's learning platform. Good luck in all your job hunt. And you can feel free to call or ask me questions. Very easy to find me, just Google me and you can find my email super easy. Thank you so much to our content expert, Dr. Adler. Tonight's presentation was fantastic and I think it's extremely valuable to all of our listeners. Before we close out, I just want to let the audience know to make sure to check out our upcoming ASGE educational events. Registration is open. Visit the ASGE website to view the complete lineup of 2023 ASGE events and to register. The next Endo Hangout session, Endoscopic Therapy in Pancreatic Disease will take place on Thursday, August 3rd from 7 p.m. to 8.30 p.m. Central Time. And will be presented by Dr. Martin L. Freeman from the University of Minnesota in Minneapolis, Minnesota. Again, registration is open. At the conclusion of this webinar, you will receive a short survey and we would appreciate your feedback. Your experience with these learning events is important to ASGE and we want to make sure we are offering interactive sessions that fit your educational needs. As a final reminder, ASGE membership for fellows is only $25 per year. $25, don't pass that up. I know, right? Oh my God. If you haven't joined yet, please contact our membership team or go to our website and make sure you sign up, $25 per year. In closing, thank you again to our content expert, Dr. Adler, this was an excellent presentation and thank you to our audience for making this session interactive. We hope this information has been useful to you and with that, I conclude our presentation. So have a wonderful night. Good night, everybody. I put my email in the chat. Thanks everyone.

job contracts

negotiation tactics

physician skills

vacation time

restrictive covenants

malpractice tail coverage

lawyer review

clinical responsibilities

fall job search